Neovascular glaucoma is a severe form of secondary glaucoma characterized by fibrovascular proliferation in the anterior chamber angle caused by chronic retinal ischemia. The most common causes are diabetic retinopathy, central retinal vein occlusion, and ocular ischemic disease. The proliferation of new blood vessels leads to the formation of a membrane that can cause open or closed angle glaucoma with very high intraocular pressure. Treatment involves controlling the underlying cause, lowering intraocular pressure through medications, laser treatment or surgery like trabeculectomy with anti-metabolites or tube shunts, and preventing further neovascularization through panretinal photocoagulation. Early diagnosis and aggressive treatment is important but successful management is challenging and
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Leukocoria ( or white pupillary reflex) is an abnormal white reflection from the eye.
Leukocoria is a medical sign for a number of several conditions.
- this presentation at annual conference of the Ophthalmic department, faculty of medicine - Al-Azhar University in association with DOS & EOS Cairo, Egypt January 2017
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
Leukocoria ( or white pupillary reflex) is an abnormal white reflection from the eye.
Leukocoria is a medical sign for a number of several conditions.
- this presentation at annual conference of the Ophthalmic department, faculty of medicine - Al-Azhar University in association with DOS & EOS Cairo, Egypt January 2017
Retinal Arterial Obstructions is a common eye disease that causes loss of vision due to the blockage of the blood flow, runs into the retina which is to be found in the back of your eye.
Central Retinal Vein Occlusion (CRVO) for undergraduate MBBS Students.
Covers the basics of Aetiology, pathophysiology, clinical features, types, associated conditions and management of CRVO.
Also encompasses salient points for PGMEE
Vitreous hemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye.[1] The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye. A variety of conditions can result in blood leaking into the vitreous humor, which can cause impaired vision, floaters, and photopsia.
It's an indepth presentation by Dr. Shah-Noor Hassan.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. DEFINITION
Severe form of secondary glaucoma characterised by fibro vascular
proliferation in the anterior chamber angle.
SYNONYMS
1. Hemorrhagic glaucoma
2. Thrombotic glaucoma
3. Rubeotic glaucoma
4. Congestive glaucoma
4. HISTORY
1906 Coats , NVI in CRVO termed as RUBEOSIS IRIDIS
1937 Kurtz , NVA leading to PAS formation
1963 Weiss et al, coined the term NEOVASCULAR GLAUCOMA
8. lens and vitreous acts as mechanical barriers and also releases vaso inhibitory
factors
So any complicated cat sx PCR,APHAKIA more predisposition
VEGF synthesised by all tissues in retina, mainly MULLERS CELL.
VEGF conc 50-100 times more in aqueous humour in NVG
9. STAGES
PRE RUBEOSIS
PRE GLAUCOMA (RUBEOSIS IRIDIS )
OPEN ANGLE GLAUCOMA
ANGLE CLOSURE GLAUCOMA
10. Pre rubeosis stage
1. In patients with predisposing risk factors such as DR, CRVO, etc it is important
to understand the risk of developing rubeosis irides and the chances for
progression to NVG.
2. Look carefully for NVI and NVA under high ,magnification
11. Pre glaucoma stage : rubeosis iridis
a. NVI +/- NVA
b. IOP normal
c. Patients are asymptomatic
d. dilated tufts of preexisting
capillaries and fine, randomly
oriented vessels on the surface of
the iris near the pupillary margin
12. Open angle glaucoma
1. Elevated IOP
2. NVA and NVI increased
3. AC inflammatory reaction
4. Hyphema may be present
5. No PAS
6. Angles open
Fibro vascular fibrovascular membrane that
covers the angle and anterior surface of the iris
and may even extend onto the posterior iris
HALLMARK
13. Angle closure glaucoma
Most patients are detected in this stage
PAS formation
Fibro vascular membrane contarcts leads to
flat iris
Ectropion uveae present
IOP very high >60 mm hg
14. CLINICAL FEATURES
SYMPTOMS
- Severe pain
- Headache ,vomiting
- Redness
- Watering
- Defective vision
- Photophobia
SIGNS
- Reduced vision
- Ciliary injection
- Corneal oedema
- Deep AC with flare
- Hyphema
- Fixed dilated pupil
- NVI, NVA
- Raised IOP
15.
16. Features Normal vessels New vessels
Location Iris stroma Pupillary margins
Angles
Arrangement Regular Irregualr
Appearance Tortuous Thin
Course Radial Arbourising
Character Not fenestrated Fenestrated
Scleral spur Not cross Crosses
Flouroscein No leakage leakage
17. DIFFERENTIAL DIAGONOSIS
1. PACG no NVI and NVA
2. UVEITIC GLAUCOMA KP’S + ,Complicated cataract, band shaped
keratopathy
3. FHI stellate KP’S, NVA+ ,NVI and NVG are rare
4. ICE syndrome corneal decompensation,correctopia,iris atrophy
5. Old trauma angle recession,iris pigment clumps, no NVI
6. Lens induced glaucoma
18. INVESTIGATIONS
OCULAR :
- Fundus Fluorescein Angiogram- to assess retinal ischaemia
-Electroretinogram – to assess for retinal ischemia
-Iris angiography- in cases of doubtful NVI, to confirm the diagnosis
-B scan ultrasound- if view of retina not
SYSTEMIC :
- BP, FBS PPBS, Carotid Doppler, lipid profile,renal profile
19. TREATMENT
A. Identifying the underlying etiology and its timely and adequate treatment to
prevent the development and progression of NVG.
B. Once NVG develops and IOP is high, the major aspect of management is
control of high IOP to prevent optic nerve damage and continuous treatment
of underlying etiology.
20. Prophylactic treatment
Pan retinal photocoagulation (PRP)
DM In established cases of PDR, PRP +/- IVB done to prevent NVG
And even after PRP, close f/u is needed
CRVO PRP indicated only after 2 clock hours of NVA/NVI (CVOS)
OIS PRP indicated for cases with retinal ischemia on FFA
refer for neurological and cardiology assessment
Pan retinal photocoagulation
Make ischemic retina anoxic
Decreased angiognic factor
Decreased new vessels
Reduces AS neo vascularisation
21. Goniophotocoagulation
a. Adjunct to PRP
b. LASER therapy aimed at directly treating the NVA before development of NVG
c. No role once glaucoma is established
d. Low-energy argon laser treatments (0.2 seconds, 50-100 um, 100 - 200 mW)
are applied to the neovascular tufts as they cross the scleral spur.
22. Management of glaucoma
Medical management
Aqueous suppressants- beta blockers, carbonic anhydrase inhibitors, alpha agonists
Topical prostaglandin analogues can be tried though they may increase ocular inflammation
Miotics are contraindicated as they can increase inflammation and discomfort.
Frequent administration of are recommended to reduce inflammation that is inevitably
present topical steroids and cycloplegics .
Anti angiogenic drugs like bevacizumab intravitreal or intra cameral, reduces angiogenesis
and reduces inflammation
23. Management of glaucoma
Surgical management :
1. Medical management with intra vitreal anti-VEGF along with retinal ablation
wherever possible may be sufficient to control the IOP in the open angle
stage of NVG
2. But in advanced stage with synechial angle closure surgical intervention for
IOP lowering is often required.
25. Trabeculectomy :
a. Intraoperative use of anti-fibrotic agents is recommended to reduce the risk
of bleb failure due to subconjunctival scarring
b. The success rate of trabeculectomy with MMC in NVG at 1 year has been
reported to be around 62.6% and reduced to 51.7% at 5 years *
c. With the use of preoperative Bevacizumab, success rate may improve up to
95%**
* Takihara Y, Inatani M, Fukushima M, Iwao K, Iwao M, Tanihara H. Trabeculectomy with mitomycin C for
neovascular glaucoma: prognostic factors for surgical failure.Am J Ophthalmol 2009; 147:912–8.
** Saito Y, Higashide T, Takeda H, Ohkubo S, Sugiyama K.Beneficial effects of preoperative intravitreal
bevacizumab on trabeculectomy outcomes in neovascular glaucoma. Acta Ophthalmol 2010; 88:96–102.
26. Tube shunts
I. Glaucoma drainage devices are increasingly being considered as a primary
surgical procedure especially NVG where there is a high risk for failure of
conventional filtering surgery
II. Scarred conjunctiva, active inflammation, vigorous new vessel growth and
prior failure of trabeculectomy are also all indications to consider tube shunt
surgery in NVG.
27. Cycloablation :
For refractive NVG, no PL eye to relieve pain,
◦ Cyclocryotherapy.
◦ TSCPC, other contact and non contact trans scleral cyclo destructive procedures.
◦ Endoscopic cyclo photocoagulation.
12-24 burn spots ,posterior to limbus over
360 degrees , 1500-2000 MW, 1.5-2 secs.
28.
29. Treatment
NVG
Seeing eye
NLP
- Medical Rx -
Cyclodestructive
procedure
Clear media
PRP
Poor media
Cryoablation
Vitreous hge
Vitrectomy+
endolaser
Trabeculectomy & Mitomycin
Tube shunts
cyclophotocoagulation
30. Conclusions
a. NVG is a potentially blinding disease
b. Early diagnosis and aggressive control of high IOP and the underlying etiology is crucial to
minimize the visual loss
c. Once IOP becomes elevated, successful management of disease becomes extremely difficult
d. No current medical or surgical treatment has a high success rate.